Provider Demographics
NPI:1063090652
Name:COLON, ASHANTI S
Entity type:Individual
Prefix:
First Name:ASHANTI
Middle Name:S
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 E GARFORD ST APT 198
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-5816
Mailing Address - Country:US
Mailing Address - Phone:916-729-9296
Mailing Address - Fax:
Practice Address - Street 1:5050 E GARFORD ST APT 198
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-5816
Practice Address - Country:US
Practice Address - Phone:916-729-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician